Endocrinology Flashcards Preview

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Flashcards in Endocrinology Deck (16)
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1
Q

What is metabolic memory in regards to diabetes?

A

The effect of prior glucose control on risk of diabetes complications

2
Q

How is LADA clinically differentiated from T2DM?

A

LADA usually rapidly progresses (<3 years) to be insulin requiring. Check Anti-GAD65 to confirm.

3
Q

What is the pathogenesis of T1DM?

A

Autoreactive T cells to Beta cells in Pancreas due to failure of thymus negative selection.

4
Q

What does a higher residual beta cell function in T1DM reduce the risk of?

A

Retinopathy and hypoglycemia

5
Q

What does the Meal Ratio mean?

A

This is the ratio of how many grams of CHO one unit of rapidly acting insulin covers to keep blood glucose in the optimal range.

6
Q

What is the Meal Ratio equation?

A

500/TDD - CHO ratio

TDD = Total Daily Dose of Insulin
CHO is carbs in grams

7
Q

What does the Insulin Sensitivity Factor used for?

A

To tell how many mmol/L the BGL will drop with 1 unit of insulin

8
Q

What is the Insulin Sensitivity Factor equation?

A

ISF = 100/TDD

TDD - Total Daily Dose of insulin

9
Q

What is the effect of Continuous Glucose Monitoring on glycemic control in adults with T1DM?

A

Reduction in HbA1c

10
Q

What is the benefit of continuous subcut insulin infusion over multiple dose injections in T1DM?

A

CSII therapy results in lower HbA1c levels, decreased insulin requirements without increased risk of hypoglycemia

11
Q

What is the Dawn Phenomenon?

A

Increased BSLs in the AM due to growth hormone and cortisol

12
Q

What factors would make a patient a good CSII candidate in T1DM?

A

Those who don’t reach glycemic goals despite adherence and maximum multiple dose injections especially if:

  • Very labile diabetes
  • Frequent Hypos/Insulin sensitivity
  • Significant Dawn Phenomenon
13
Q

What complications does tight glycemic control reduce in the short term?

A

Reduced microvascular complications; specifically - Retinopathy and nephropathy (DCCT Study 1990)

14
Q

What complications does tight glycemic control reduce in the long term?

A

42% reduction in macrovascular events (EDIC Study)

15
Q

List the 4 counterregulatory responses to hypoglycemia in order.

A
  1. Reduced Insulin secretion
  2. Increased Glucagon secretion (Transient glycogenolysis)
  3. Increased Adrenaline secretion (Hepatic glycogenolysis and gluconeogenesis)
  4. Increased Cortisol and GH secretion
16
Q

What is the pathophysiology of of hypoglycemic unawareness?

A

Reduced sympathoadrenal response resulting in absent or reduced neurogenic symptoms. Occurs via decreased SNS output from CNS.